the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Thursday, July 15, 2010

silence

one expects a certain level of dignity and decorum from your surgeon. there was an incident when this was so not the case the ensuing astoundment caused such a deep silence one could almost hear a pin drop. it's a pity we didn't.

it was one of those cases you see where some kid has swallowed some object he shouldn't have. this time the x-ray revealed a pin which seemed to be in the kid's stomach. amazingly enough if it gets through the stomach it most likely will make its way throughout the entire intestinal canal and can be left on its somewhat crappy journey. but being in the stomach it is also quite accessible with a simple gastroscope which is not too invasive. the parents were keen for me to try to get it out and i was up for that.

we settled the kid on the scope table and inserted the drip with much weeping and gnashing of teeth. the kid was doing the weeping and i was doing the gnashing of teeth. but once it was up the sedation and procedure we knew would be no problem.

the sedation was injected and quite soon i was peeping into the stomach with my trusty scope. only problem was there was no pin to be seen. i looked at the x-rays again. there the pin was clearly in the stomach and the x-rays had just been taken. that meant the pin couldn't have gone too far. i advanced the gastroscope into the first part of the duodenum (the part of the bowel just distal from the stomach). still no pin. not to be discouraged by disappearing pins i just kept on advancing the scope but still the pin was nowhere to be seen.

finally when i came to the part of the duodenum that straddles the aorta (a big pulsating artery) sure enough there was the pin jumping up and down with apparent glee with each pulsation. it seemed a pity to go to so much trouble to find it and then just leave it there, even if it looked like it was having fun, so i asked the sister to ready the biopsy forceps (that was the only grasping scope instrument we had) and i prepared to remove it.

as i discovered it is not so easy to grab the head of a pin with something not much bigger than the head of a pin, especially when with every attempt the pin bounces around in rhythm to the patient's beating heart. the procedure started getting a bit longer than i thought it was going to be. i wondered what the parents waiting outside would be thinking by this time.

i was just considering giving the whole idea up for lost when the pin seemed to jump into the mouth of the biopsy forceps and we grabbed it. we had a moment or two of panic when the now immobile pin seemed ready to stab the aorta with each pulsation that had so recently been its play mate (pins can be so fickle). so we quickly withdrew it into the stomach...where we accidentally let it go.

the procedure was getting a bit too long and the parents were probably wondering exactly what i meant when i told them it would take no more than five minutes. nevertheless, after working so hard to return the pin to the stomach where it was supposed to be in the first place, i couldn't exactly stop the procedure then. i soldiered on.

it is surprisingly difficult to pick up a pin in the stomach with biopsy forceps through a gastroscope, even for those practised in the fine are of retrieving pins from the distal duodenum as i was. i started to sweat a bit, but i was now in it for the long run. and finally i did get a hold of that blasted elusive pin. i told the sister to hold the forceps as tightly closed as possible and we withdrew it.

we stood there looking at this pin now held by the forceps, but outside the body with what i think was a sort of grudging admiration. i reached for it and the sister released the forceps and...well the pin just disappeared. we looked at each other in silent horror.

"did you see where it dropped?" the sister asked.

"no."

"did you hear it drop?"

"it wasn't that quiet."

yet even then the humour of it was not lost on me. i could just imagine explaining to the parents;

"sorry we took so long but the pin was much further than we thought it would be."

"so you didn't get it out?"

"no we did get it out."

"great. can i see it please?"

"uuuummm...."

the child was still asleep so we had a bit of time. we both dropped to our knees and started searching the floor. but the pin had disappeared. it seemed its super powers weren't just limited to when it was inside the kid, but it retained its elusiveness outside of him as well.

then i wondered what the child would think if he woke up just at that moment to see his surgeon and the sister scurrying around on their hands and knees with their noses right up against the floor. i considered sedating him a bit more so we could find the pin in peace but that somehow seemed wrong. the next thought got to my mouth before i had even properly formulated it.

"sister, don't we have a similar pin somewhere here that we can give to the parents and just tell them it's the one we removed from their kid?" she laughed. i was just about to tell her i wasn't making a joke when the patient started groaning as he slowly woke up. i jumped to my feet, a bit too quickly i fear and brushed myself off. to her credit the sister continued on her quadrupedal quest.

about a minute later, as the child started looking around and demanding his mother, the sister suddenly jumped up with the pin firmly grasped between her fingers. we quickly put it into a specimen container so that it could no longer escape.

i then walked casually out of the procedure room with all the dignity and decorum i could muster and presented this prize to the parents. they had no idea how hard i had worked for it.

6 comments:

When I drop small things (I'm a little clumsy - psych for me, not surgery!), I always turn down the lights and shine a torch sideways so that whatever is on the floor makes a tiny shadow as I scuttle around searching for it.

ugh when we were in needlework class at school and ate pins we had to go to sick bay where we were forced to eat a cotton wool sandwich. on a more serious note, can you really make and NasoJeginal tube travel into the Jejinim by using a magnet?

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the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.